Occupational therapy improves functional recovery and reduces delirium in critically ill adults with and without stroke: a systematic review and meta-analysis.

Background: Post-intensive care syndrome (PICS), encompassing physical, psychological, and cognitive impairments, significantly compromises recovery in critical illness survivors. Although occupational therapy (OT) may mitigate functional decline, its efficacy in the intensive care unit (ICU) remains inadequately established. This systematic review and meta-analysis evaluated the impact of OT on clinical outcomes in critically ill adults. Methods: We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Library, CNKI, Wanfang, and China Biomedical Literature Service System from inception to August 5, 2025 for randomized controlled trials (RCTs) assessing ICU-based OT. Primary outcomes included activities of daily living (ADL), delirium incidence, grip strength, and mechanical ventilation duration. Data were synthesized using RevMan 5.3, with continuous outcomes expressed as mean difference (MD) or standardized mean difference (SMD) and dichotomous outcomes as relative risk (RR), all with 95% confidence intervals (CIs). The certainty of evidence for each outcome was assessed using the GRADE approach. Results: Pooled analyses demonstrated that OT significantly enhanced ADL performance [SMD = 0.72, 95% CI (0.40, 1.05), Conclusion: This meta-analysis provides evidence that OT may enhance functional recovery, prevent delirium, and facilitate weaning in critically ill patients. However, the strength of the evidence is low to moderate, tempered by the limited number of trials, risk of bias, and observed heterogeneity. These findings underscore the need for further rigorous investigation to establish optimal protocols. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/recorddashboard, Unique identifier: CRD42025312345.